How to deliver twins
Giving birth to twins | Pregnancy Birth and Baby
Twins are more likely to be born early, often before 38 weeks, so it's important to understand your birth options. Less than half of all twin pregnancies last beyond 37 weeks.
Because of the likelihood that your babies will be born early, there is a good chance one or both of them will spend some time in special care.
As twins are often born prematurely, it's a good idea to discuss birth options with your midwife or doctor early in your pregnancy.
You should also discuss where you would like to give birth. You will most likely be advised to give birth in a hospital because there's a higher chance of complications with a twin birth.
It's common for more medical staff to be involved in the birth of twins, such as a midwife, an obstetrician and two paediatricians - one for each baby.
While the process of labour is the same as when single babies are born, twin babies are more closely monitored. To do this, an electronic monitor and a scalp clip might be fitted on the first baby once your waters have broken. You will be given a drip in case it is needed later.
Vaginal birth
About one third of all twins are born vaginally and the process is similar to that of giving birth to a single baby. If you're planning a vaginal delivery, it's usually recommended that you have an epidural for pain relief. This is because, if there are problems, it's easier and quicker to assist the delivery when the mother already has good pain relief.
If the first twin is in a head down position (cephalic), it's usual to consider having a vaginal birth. However, there may be other medical reasons why this would not be possible. If you have had a previous caesarean section, it's usually not recommended you have a vaginal birth with twins.
If you have a vaginal birth, you may need an assisted birth, which is when a suction cup (ventouse) or forceps are used to help deliver the babies.
Once the first baby is born, the midwife or doctor will check the position of the second baby by feeling your abdomen and doing a vaginal examination.
If the second baby is in a good position, the waters will be broken and this baby should be born soon after the first as the cervix is already fully dilated. If contractions stop after the first birth, hormones will be added to the drip to restart them.
Caesarean section
You may choose to have an elective caesarean from the outset of your pregnancy, or your doctor may recommend a caesarean section later in the pregnancy as a result of potential complications. You’re nearly twice as likely to have a caesarean if you’re giving birth to twins than if you’re giving birth to a single baby.
The babies' position may determine whether they need to be delivered by caesarean section or not. If the presenting baby - the one that will be born first - is in a breech position (feet, knees or buttocks first), or if one twin is lying in a transverse position (with its body lying sideways), you will need to have a caesarean section.
Some conditions also mean you will need a caesarean section; for example if you have placenta praevia (a low-lying placenta) or if your twins share a placenta.
If you have previously had a very difficult delivery with a single baby, you may be advised to have a caesarean section with twins. Even if you plan a vaginal birth, you may end up having an emergency caesarean section.
This could be because:
- one or both babies become distressed
- the umbilical cord prolapses (falls into the birth canal ahead of the baby)
- your blood pressure is going up
- the labour is progressing too slowly
- assisted delivery doesn't work
In very rare cases, you may deliver one twin vaginally and then require a caesarean section to deliver the second twin if it becomes distressed.
After the birth
After the birth, your midwife will examine the placenta to determine what type of twins you have. Twins can either be fraternal or identical.
If your babies need special care
Depending on where you plan to give birth, you may need to go to another hospital with appropriate facilities if complications in your pregnancy indicate you're likely to have an early delivery.
This may not be near to home, so make sure to check there are enough beds for both your babies in the neonatal unit.
Ask if your chosen hospital has a transitional care unit or a special care nursery. These are places that allow mothers to care for their babies if they need special care but not intensive care. These hospitals are more likely to be able to keep you and your babies in the same place.
You might also want to ask if your hospital has cots that allow co-bedding (where your babies sleep in a single cot), if this is appropriate and if you want your babies to sleep together.
If you have one baby in the hospital and one at home, you will need to think about splitting your time between the two. When you visit your baby in hospital, ask if you can bring their twin and if co-bedding is allowed during visits.
If you want to breastfeed and only one twin can feed effectively, you may need to express milk to feed the twin who is having trouble feeding. You may then need to put the twin who can feed on the breast to encourage milk production in order to get enough milk to feed both babies.
Check if your hospital offers support from a community neonatal nurse, which would allow for you and your babies to leave hospital earlier, for example if your baby is still tube-fed.
When you go to clinics for follow-up appointments, it's a good idea to ask not to be booked into early morning appointments. Getting out of the house with two babies, particularly if one is unwell, can be difficult.
For more information and support, visit Twins Research Australia.
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Giving birth to twins or more
It's important to understand your birth options if you're expecting more than 1 baby.
Twins and triplets are more likely to be born early and need special care after birth than single babies.
Your birth choices with twins
It's a good idea to discuss your birth options with your midwife or consultant early on in your pregnancy.
You'll normally be advised to give birth in a hospital, as there's a higher chance of complications with twins.
There are usually more health professionals at a multiple birth – for example, there may be 2 midwives, an obstetrician and 2 paediatricians (1 for each baby).
For more information on who's who, read about the antenatal team.
The process of labour is more or less the same as for 1 baby, but your maternity team will usually advise you to have your babies electronically monitored because of the higher risk of complications.
This means attaching belts with sensors (1 for each twin) to your bump. You'll still be able to move around into different positions.
Once your waters have broken, your midwife may ask your permission to attach a clip attached to a wire to the first baby's head to get a more accurate measure of their heartbeat.
You'll be offered a drip in case it's needed later – for example, to restart contractions after your first baby is born.
Triplets or more babies are almost always delivered by a planned caesarean section.
Can you have a natural birth with twins?
Lots of women think they have to have a caesarean section with twins, but in fact, many twin births are vaginal
If you're planning a vaginal delivery, it's usually recommended that you have an epidural for pain relief, but you can discuss this with your midwife.
If there are any problems, it's easier for your antenatal team to deliver your babies quickly if you have already got an epidural in place.
Find out more about the signs and stages of labour
You're more likely to have a vaginal birth if the first twin is in a head-down position.
But there may be medical reasons why a vaginal birth is not recommended.
If you have had a caesarean section before, for example, it's not usually recommended that you have a vaginal birth with twins.
As with any vaginal birth, you may need an assisted birth. This is where forceps or vacuum delivery are used to help deliver your babies.
Once the first baby is born, your midwife or doctor can check the position of the second baby by feeling your tummy and doing a vaginal examination. They may also use an ultrasound scan.
If the second baby is in a good position, it should be born soon after the first, as your cervix is already fully dilated.
If your contractions stop after the first baby is born, the doctor or midwife may discuss giving you hormones via a drip to restart them.
Caesarean section and twins
In the UK, more than half of twins and almost all triplets are delivered by caesarean section is a common method used during twin and triplet births.
You may choose to have a planned caesarean, or your doctor may recommend a caesarean, if:
- the first baby is lying feet, knees or buttocks first (breech)
- 1 twin is lying sideways (transverse)
- you have a low-lying placenta
- your twins share a placenta
- you have had a difficult delivery with a single baby before
As with any pregnancy, if you plan a vaginal birth, you may still end up needing an emergency caesarean.
In a small number of cases, some women deliver 1 twin vaginally and then need a caesarean section to deliver the second twin.
Video: how can my twin or multiple births be managed?
In this video, a midwife explains what can happen when giving birth to more than 1 baby.
Media last reviewed: 1 November 2019
Media review due: 2 November 2022
Page last reviewed: 31 October 2022
Next review due: 31 October 2025
Pregnancy planning: how to conceive twins
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Birth of twins: what is the probability? | PHARMACY
Twins or dizygotic twins are born when 2 different eggs are fertilized by 2 different sperm at the same time. Identical twins, or homozygous twins, give birth if 1 egg is fertilized by 1 sperm and then divides, forming 2 embryos. Identical twin births occur around the world with approximately the same frequency of 3-4 cases per 1000 births, the frequency of birth of dizygotic twins varies significantly around the world, from 6 cases per 1000 births in Asia to 40 cases per 1000 births in Africa.
nine0003
Scientists believe that the birth of twins is based on a genetic component, but the details of this relationship have not previously been sufficiently studied. In a new study, scientists from the Free University of Amsterdam (Vrije Universiteit), the Netherlands, have identified 2 gene variants associated with the birth of dizygotic twins.
The results of the study are relevant for the European population, since the population of Asia and Africa may have additional gene variants, scientists note. nine0003
Until now, researchers have not been able to analyze in detail some of the factors that likely increase a woman's chances of having twins. For example, women who became mothers in adulthood and those who had relatives who gave birth to twins were more likely to have dizygotic twins than other females. Therefore, the researchers decided to analyze the genes responsible for the birth of twins. They started by collecting genetic information from databases in the Netherlands, Australia, and the United States.
As a result, they identified 1980 mothers of twins conceived without infertility treatment and compared their genome with that of 12,953 women from the control group who did not give birth to dizygotic twins.
After searching for and isolating the genetic variants that distinguish mothers from the two groups, the scientists sent the results to their colleagues in Iceland, who conducted a similar study on 3,597 mothers who gave birth to dizygotic twins and 297,348 women from the control group.
This allowed us to identify 2 gene variants that appeared more often in mothers of twins than in mothers who gave birth to 1 child. One gene variant is associated with increased levels of follicle-stimulating hormone (FSH) in women, and also plays an important role in reproductive function in men. FSH stimulates a woman's ovaries to release an egg. Its elevated level can lead to the simultaneous release of several eggs from the ovaries, which can subsequently lead to the fertilization of 2 eggs at once and the birth of twins.
